Oral Health

Latest OHWG statement at the World Health Assembly

Agenda point 17 K - Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage

Call to exempt tax on dental supplies and equipment for infection control and prevention

World Federation of Public Health Associations (WFPHA) speaking note

Chairperson, Excellences, and Distinguished Colleagues,

WFPHA is an NGO composed of multidisciplinary national public health associations with an oral health group.

The WHO Global Oral Health Programme has worked hard to put oral health high on the health agenda of policy and decision-makers in the world and has emphasized the importance of an integrated disease prevention approach. Universal oral health care provision is an essential goal in public health to increase the access to appropriate and timely oral health care for all. However, the quality and safety of healthcare must be assured regardless of various global healthcare settings to achieve the basic principle of health care: do no harm.

The WFPHA OHWG is aware that people in poor and marginalized communities, especially in low-income countries, may not be able to access or afford dental care which is provided to internationally acceptable standards of infection control. Policymakers and corporates need to work together to ensure safe dental treatment available and affordable for people from all income levels.

Breakdowns of infection prevention and control can occur when proper sterilization and monitoring fail or unsafe injection practices occur. While science, evidence and open resources are available, actual changes happen only with coordinate efforts and political interests to connect those available resources. This approach fitting with WFPHA Global Charter for the Public’s Health Prevention and Promotion core services as well with the good Governance and Advocacy enabler functions.

The WFPHA therefore urges for tax exemption for dental supplies and equipment for infection control and prevention. Safe dentistry should be available and affordable. Local and national governments should provide practical resources to healthcare facilities that provide dental services in partnership with international organizations and corporate partners. This shall be the beginning of a process embracing the development of protecting strategies providing integrated preventive solutions.

Latest Resolutions

Exempt Tax on Dental Supplies and Equipment for Infection Control and Prevention

Introduction

I.The Need of Safe Dentistry

The provision of universal oral health care is a major goal in public health systems in order to increase access to appropriate and timely oral health care for all. In all cases, the quality and safety of oral healthcare must be assured regardless of various global healthcare settings to achieve the basic principle of health care: do no harm. The U.S. National Academies of Sciences, Engineering, and Medicine defined six components of quality healthcare in it’s the “Crossing the Quality Chasm” report: safe, effective, patient-centered, timely, efficient and equitable.(1) Since the report was issued, there has been a rapid introduction of innovative models for configurations of the healthcare workforce and delivery vehicles to assure the quality and safety of healthcare systems. The oral health profession has been a leader in implementing quality initiatives; for example, they were the leaders ahead of other health professions in incorporating hepatitis B virus (HBV) vaccinations for personnel members a few decades ago.(2) However, safe dentistry needs to be assured in various global oral health care settings that may have different levels of education and resources.

II.Infection Control and Prevention in Dental Settings

Breakdowns of infection prevention and control can occur when proper sterilization and monitoring fail or unsafe injection practices occur. In 2003, and again in 2016, the Centers for Disease Control & Prevention released recommendation guidelines for infection control practices in dental offices nationally and globally to provide direction for the public, dental health care personnel and policymakers.(3, 4)Although these knowledge resources are available free online with a mobile apps and other communication tools, health professionals may not know about them or cannot comply with the recommendations when practical resources are not affordable or available. A major review of the available literature on infection control and prevention in oral health-care facilities revealed that the resources and training opportunities for infection control and prevention for oral health are more limited in developing countries.(5) The current infection control and prevention practice in different countries range from dry heat and autoclave sterilization with biomarkers to boiling water sterilization without individual pouch and multiple re-use of disinfectant. Cross-contamination with digital technology and inadequate hand washing was another major concern.

II.Availability and Affordability of Infection Control in Dental Settings

Dental extraction is a common treatment and can be the only definite care option when other treatment options are not available. The basic need for safe extraction includes disposable needles, lidocaine carpules, gauze, sterilized syringes and forceps, safe needle recapping devices, disinfectant wipes, autoclave machine and sleeves, clean water, and a labor fee for healthcare workers. The cost of the disposable items is many countries is about US $1.(6) If we assume that all other dental costs, including the professional fee, is a dollar, more than 10% of world population must pay their daily earnings for tooth extraction. In a survey conducted in Tanzania, the expense for extractions and single surface, one-tooth fillings were compared with daily resources for adult required for basic consumption (DRC).(7) Extractions were found to cost patients an average of four-times their DRC and restorations were on average 9–10 times the DRC.(7) When the cost of standard dental services is unaffordable in low-income countries, it is sensible decision that the cost of infection control and prevention in dental care settings should be subsidized by local and national government to assure safe dentistry.

Scope and purpose

People in poor and marginalized communities, especially in low-income countries, may not be able to access or afford dental care which is provided to internationally acceptable standards of infection control. Policymakers and corporates need to work together to ensure safe dental treatment available and affordable for people from all income levels. While science, evidence and open resources are available, actual changes happen only with coordinate efforts and political will to connect those available resources. This approach to infection control and prevention is consistent the WFPHA Global Charter for the Public’s Health Prevention and Promotion.(8, 9)

Fields of applications

National public health associations and their members

Health care professionals and delivery systems

Oral health professionals and organizations

International non-governmental organizations

Academic institutions

Ministries of health

Call to action

To respond to this urgent need of safe dentistry in all countries, the World Federation of Public Health Associations urges the following:

Implementation of safe dentistry practice that is available and affordable.

Implementation of a tax exemption for dental supplies and equipment for infection control and prevention.

Partnerships between local and national governments and international organizations and corporations to provide practical resources to healthcare facilities that provide dental services

Coordinated efforts to achieve infection control in dental settings, especially those in remote and marginalized communities.

Previous Resolutions

2016

In May 2016, the resolution on the integration of oral health into primary health care and public health systems proposed by the Oral Health Working Group have been approved by the WFPHA General Assembly. Moreover a statement on the same topic has been added among the official statements of the 69th World Health Assembly.

Resolution "The integration of oral health into primary health care and public health systems"

The WFPHA recommends the integration of oral health within public health systems through:• Integration of oral health within national health policies, including fluoridation• Integration of oral health within health service planning, emphasizing primary and preventive oral health care• Integration of oral health within public health and primary health care personnel training and practice, developing the role of primary care personnel to improve oral health• Inclusion of senior dental personnel with public health training within Departments of Health at national and local levels to lead the integration of oral health within national public health plans• Increased research to support and advance the integration of oral health within overall health

Statement on the integration of oral health into primary health care and public health systems

World Health Assembly, Geneva, 23-28 May 2016

Agenda point 16.1 Health workforce and services

World Federation of Public Health Associations (WFPHA) speaking note

Chairperson, Excellences, and Distinguished Colleagues,

The WFPHA is an international, nongovernmental organization composed of multidisciplinary national public health associations with an oral health working group.

The World Health Organization Global Oral Health Programme has worked hard over the years to put oral health high on the health agenda of policy and decision-makers in the world and has emphasized the importance of an integrated disease prevention approach. Oral diseases have common risk factors with other major chronic and non-communicable diseases and can be addressed through the integration of oral health within public health systems.

The WFPHA is aware that to recognize oral health as an integral part of overall health, public health care systems globally must include a comprehensive approach to oral health using the following strategies: integration of oral health into primary health care systems, mechanisms for inter-professional collaboration, community based prevention, and oral health promotion among all healthcare providers.

If we are to achieve this aim, we need to train a cadre of public health leaders, champions who can drive forward progressive agendas and spearhead systemic change at local, national and global levels, mobilizing a genuine political acknowledgement of, engagement with and leadership for the public’s health supported by a global public health system integrating oral health.

The WFPHA therefore urges that particular attention is paid to addressing this problem through high-level continuous education and training of leaders who can implement strategies and advocate for better oral health. This shall be the beginning of a process embracing the development of strategic capacities for all professionals that will be part of a new health era, more dedicated to common integrated preventive solutions.

Thanks you!

2015

Resolution on Oral Cancer Prevention

The WFPHA resolution calls for:

▪ The need to implement WHO FCTC to harness the full potential of tobacco control in oral cancer prevention.

▪ Control measures for tobacco to also apply towards smokeless tobacco and commonly related products such as paan tobacco, areca nut, paan masala and other variant forms.

▪ Sustained awareness campaigns for tobacco control measures. These may include pictorial warnings on labels, enforcing and encouraging policies banning smoking in public places, strengthening legislation and increasing taxation.

▪ The early detection of oral precancerous lesions and preclinical early invasive cancer in primary care, specifically for users of alcohol and tobacco.

▪ Investments in health services to facilitate clinical suspicion and prompt referral of suspected oral cancer patients. This can result in early diagnosis, treatment and follow-up care.

Through these measures it is possible to detect, control and ultimately prevent oral cancer worldwide.

Resolution on Dental Public Health Workforce Infrastructure

The WFPHA recommends:

▪ All countries should have an oral health professional with public health training and experience in the Minister of Health’s Office to develop policies, plans and programs, promote oral health, prevent oral diseases and to make maximum use of oral health resources in their country to respond to this neglected epidemic.

▪ Every country should have and/or develop a dental public health infrastructure, which consists of oral health professionals with training and experience in public health, working with or in local, regional and national health departments in developing and planning public health programs, which shall include oral health components.

▪ All dental schools, hygiene schools, dental assisting, and dental therapy schools in every country should include dental public health in their curriculum, especially population-based prevention and services.

2014

Oral Health for Individuals with Dementia

In May 2014, the Resolution “Oral Health for Individuals with Dementia” proposed by the Oral Health Working Group and cosigned by the International Council of Nurses, has been approved by the WFPHA General Assembly and got very positive feedbacks.

The WFPHA OHWG is aware that one overlooked problem in the group of older adults relates to poor oral hygiene. Oral health is a frequently neglected aspect of general (public) health. The prevalence of dementia is increasing worldwide. It is increasingly evident that because those who are demented frequently have difficulty in communicating with their carers (caretakers), they often suffer unnecessarily. This resolution seeks to address one aspect of this problem, which relates to poor oral health in the elderly.

With this resolution, the WFPHA OHWG therefore urges that particular attention is paid to addressing this problem at all levels, with the active participation of national public health associations and allied groups, in a national and global response to raising awareness of the problem and ensuring that carers (caretakers) are trained to prevent it and do so.

Resolutions Implementation

In May 2015 in Mexico City, the resolution on Access to Oral Health for Children, passed by the WFPHA GA in 2013, was formally adopted by Mexico City government and staff as part of a program that will incorporate healthy eating, hand-washing and tooth brushing in schools. A formal dinner was held to sign the agreement; Colgate Mexico was/are involved.

Advanced Dental Leadership program

After 10 years of the successful Senior Dental leadership program developing the strategic leadership skills of 400 senior dental leaders, the Global Child Dental Fund charity has developed the Advanced Dental Leadership program – level 1 (ADL1). This program targets final year dental students and younger dental professionals worldwide, aiming to develop the leadership skills that will prepare the emerging generation of global dentists to perform in the increasingly competitive and evolving arena of modern dentistry.

The ADL1 program is structured around 20hrs of Continuing Professional Development (CPD) modules in oral health leadership, provide a verified certificate from the Global Child Dental Fund charity upon completion, is available in multiple countries and languages and costs £40 to sign up for all the interactive course materials.

A subgroup of WFPHA Oral Health working group has been involved in this ADL1 program making this activity one of the project sustained by the group. These professionals engaged in bringing their public health vision within the dental profession. The plan is to contribute to ADL1 as well as to develop the teaching activities to further levels in the next future.

WFPHA has accredited the Advanced Dental Leadership program developed by the Global Child Dental Fund charity directly and through its Oral Health Working Group. The WFPHA recognizes the importance of this program in capacity building and increasing leadership in oral and public health in general.

In 2016 the World Federation of Public Health Associations has accredited also Global Child Dental Fund's new Online Advanced Dental Leadership Programme. This exciting programme develops medical nurses and allied health professionals into first class leaders and advocated for oral health. It will impart the essential leadership skills and oral health knowledge necessary to improve effectiveness of health professionals, develop understanding of key oral health components, and successfully integrate the two areas into daily practice. The WFPHA has recognised the importance of the programme in increasing leadership capacity in oral and public health.

North and South Americas

Oral Health @ World Congress on Public Health

15th World Congress on Public Health

The OHWG has actively participated to the 15th World Congress on Public Health with “Universal dental care provision - will it really improve oral health?” World Leadership Dialogue. The dialogue have explored how the Global Charter can be used strategically to promote global oral health with multi-sectoral partners in integrative approaches. Speakers have elaborated on universal oral health provision and integration of oral health in primary care with tangible examples and key solutions, including Regional Oral Health Centres. Regional Oral Health Centres are expecting to co-ordinate local training and educational projects, promote oral health to neighboring countries, train workforce and provide leadership guidance and development.

14th World Congress on Public Health

The OHWG has actively participated to the 14 World Congress on Public Health with one Workshop on Oral Cancer Prevention and a Concurrent session on Dental Public Health Capacity.

Workshop on Oral Cancer Prevention

The Workshop on Oral Cancer Prevention has investigated the current status of oral cancer prevention and control in the world, with particular emphasis on the Indian sub-continent which contributes a lion’s share of global burden of oral cancer. The proposed topics in the workshop included the global burden, incidence and mortality trends, primary prevention and early detection of oral cancer. The deliberation on global burden of disease included estimates of incident and prevalent oral cancer cases and oral cancer deaths in the world and in different WHO regions of the world for 2012 and projections for 2020 and 2030, as well as global trends in incidence and mortality as related to the underlying trends in the prevalence of major risk factors. The Public Health aspect of primary prevention of oral cancer dealt with global efforts in tobacco control measures in the context of implementation of WHO framework Convention on Tobacco Control (FCTC) in various countries, with particular focus on South East Asia, efforts in Alcohol control and in improving uptake of vegetables and fruits and healthy diets as well as in improving oral hygiene. The session dealt with the natural history of oral cancer, current evidence on the accuracy as well as efficacy and cost effectiveness of different early detection methods in reducing oral cancer mortality and the current progress in implementation of population based oral cancer early detection programs in routine health services. The seminar has discussed also WFPHA resolution on Oral Cancer prevention and control.

Workshop on Oral Cancer Prevention speakers and Chairs (click on the corresponding name to read the presentation):

The OHWG has led a survey to map Dental Public Health Capacity worldwide. The results of this survey give an overview of the strong and weak points of Dental Public Health Capacity in the different regions of the world as well and an insight in the integration between Oral and Public Health.

The session has provided a general overview of Dental Public Health capacity in the world with a special focus on the Eastern Mediterranean region. The session has been completed by the resolution on Dental Public Health Workforce Infrastructure elaborated by the Oral Health Working Group and approved by WFPHA General Assembly.

Concurrent session on Dental Public Health Capacity speakers and Chairs (click on the corresponding name to read the presentation):

The Working Group

In April 2012 the World Federation of Public Health Association (WFPHA) general assembly and council of the WFPHA approved the establishment of the WFPHA Oral Health working group (OHWG).

For the second term (2015-2018), the chairman is Prof. Raman Bedi (UK) with Hyewon lee (USA) and two vice chairs are Dr. Ken Eaton (UK) and Dr. Myron Allukian (USA). The group is aided by Prof. Bettina Borisch (Head of the WFPHA) and by Dr. Marta Lomazzi as executive coordinator of the WG.

The Oral Health working group will consider all aspects of oral health and notes that the WFPHA has an existing specific project on dental caries with the Alliance for Cavity Free Future.

News and Latest Reports

The Oral Health Working Group (OHWG) has put into place several important initiatives in 2016.

The group has published in the Journal of Public Health Policy the article “Dental public health (DPH) capacity worldwide: Results of a global survey”. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision. The results will be presented at the upcoming 15 World Congress on Public Health.

In May 2016, the resolutions on "The integration of oral health into primary health care and public health systems" proposed by the Oral Health Working Group have been approved by the WFPHA General Assembly. The resolution recommends the integration of oral health within public health systems through integration of oral health within national health policies, health service planning, public health and primary health care personnel training and practice, developing the role of primary care personnel to improve oral health, inclusion of senior dental personnel with public health training within Departments of Health and increased research to support and advance the integration of oral health within overall health. A statement on the same topic has been added among the official documents of the 2016 World Health Assembly. The statement urged that particular attention is paid to addressing this problem through high-level continuous education and training of leaders who can implement strategies and advocate for better oral health.

A subgroup of OHWG has been involved in the Advanced Dental Leadership (ADL) program for young dentists and for Medical Nurses & Healthcare Professionals, developed by the Global Child Dental Fund, making these activity one of the project sustained by the group. The World Federation of Public Health Association has accredited ADL, recognizing the importance of the program in increasing leadership capacity in oral and public health.

The OHWG will actively participated to the 15th World Congress on Public Health with “Universal dental care provision - will it really improve oral health?” World Leadership Dialogue. The dialogue will explore how the Global Charter can be used strategically to promote global oral health with multi-sectoral partners in integrative approaches. Speakers will elaborate on universal oral health provision and integration of oral health in primary care with tangible examples and key solutions, including Regional Oral Health Centres. Regional Oral Health Centres are expecting to co-ordinate local training and educational projects, promote oral health to neighboring countries, train workforce and provide leadership guidance and development. Regional Oral Health Centres establishment will represent the main project of the group for the next term and will showcase how the Global Charter for the Public’s Health can be implemented within this setting.